Healthcare Provider Details

I. General information

NPI: 1235392424
Provider Name (Legal Business Name): JAMIE B RAISOR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 LAFAYETTE PKWY STE 240
LAGRANGE GA
30241-3734
US

IV. Provider business mailing address

5310 HARVEST HILL RD STE 290
DALLAS TX
75230-5826
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-8400
  • Fax:
Mailing address:
  • Phone: 214-420-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127054
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN145004
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: